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Postextrasystolic potentiation and dobutamine echocardiography in predicting recovery of myocardial function after
R Scognamiglio1, G Fasoli, D Casarotto
1Department of Clinical and Experimental Medicine, University of Padua, Italy.
Insights
Postextrasystolic potentiation (PESP) echocardiography is a sensitive and accurate method for identifying viable myocardium in patients with coronary artery disease, outperforming dobutamine stress testing.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Identifying hibernating myocardium is crucial for myocardial revascularization.
- Echocardiography aids in detecting reversible contractile dysfunction for surgical selection.
Purpose of the Study:
- To evaluate the efficacy of postextrasystolic potentiation (PESP) echocardiography versus dobutamine infusion for identifying viable myocardium.
Main Methods:
- Prospective study of 60 patients with chronic multivessel coronary artery disease.
- Assessed reversible contractile dysfunction using dobutamine infusion (low and intermediate doses) and PESP.
- Compared sensitivity and predictive accuracy of both methods.
Main Results:
- PESP demonstrated higher sensitivity (92% vs. 86%) and predictive accuracy (89% vs. 84%) compared to dobutamine.
- Combining dobutamine and PESP did not improve diagnostic performance.
- Dobutamine at intermediate dose induced ischemia in 15% of patients; low dose reduced sensitivity.
Conclusions:
- PESP echocardiography is a valuable, cost-effective tool for identifying viable myocardium in multivessel coronary disease.
- PESP is more sensitive and accurate than dobutamine infusion for this purpose.
Background:
Identification of viable but hibernating myocardium remains a relevant issue in the current era of myocardial revascularization. Echocardiography can be helpful in detecting reversible contractile dysfunction and optimizing the selection of patients for coronary bypass surgery.
Methods And Results:
Eighty-four consecutive candidates for bypass surgery with chronic multivessel coronary artery disease were screened, and 60 were included in this prospective study. Preoperative evaluation of a reversible contractile dysfunction in asynergic myocardial regions was performed by dobutamine infusion at 5 (low dose) and 10 (intermediate dose) microg x kg(-1) x min(-1) with each stage lasting at least 5 minutes; postextrasystolic potentiation (PESP), with a coupling interval ranging from 500 to 300 ms with a progressive 10-ms decrease; or a combination of both dobutamine infusion and PESP. Sensitivity (92% versus 86%) and predictive accuracy (89% versus 84%) were higher with PESP than dobutamine (P=.009 and P=.001, respectively), but the combination did not improve sensitivity or accuracy. Dobutamine induced ischemic dysfunction in 15% of patients at the intermediate dose; however, the low dose resulted in loss of sensitivity.
Conclusions:
PESP echocardiography is a useful and cost-effective method to identify viable myocardium in patients with multivessel coronary disease undergoing revascularization and is more sensitive and accurate than dobutamine infusion.